Diagnostic ultrasound ( PDFDrive )

CHAPTER 11 The Adrenal Glands 425
A
B
C
FIG. 11.10 Adrenal Calciication. (A) Sagittal and
(B) transverse sonograms show a heterogeneous right adrenal
mass with coarse echogenic foci and shadowing. See also
Video 11.4. (C) In a different patient, sagittal sonogram shows
a partially calciied adrenal mass with acoustic shadowing.
(C courtesy of Dr. Mitchell Tublin.)
ith decade of life. 44,51 Increased prevalence has been reported
in patients with particular familial neoplastic syndromes, including
familial adenomatous polyposis, Beckwith-Wiedemann syndrome,
and Li-Fraumeni syndrome, Carney syndrome, MEN
I, as well as mutations involving the p53 tumor suppressor gene. 45,51
Adrenocortical carcinomas are hyperfunctioning in 55% to 78%
of cases, manifesting with Cushing syndrome, virilization or
precocious puberty, feminization in males, primary hyperaldosteronism,
or combined hormonal excess in 33%, 35%, 10%, 2.5%,
and 3% of cases, respectively. 46 Functioning adrenocortical
carcinomas are oten diagnosed at an earlier stage because of
their clinical symptomatology and can therefore measure less
than 6 cm in size. Nonfunctioning adrenocortical carcinomas
are large, with 81% to 90% measuring over 6 cm at the time of
diagnosis (Fig. 11.11). 47 Because of their later presentation,
nonfunctional carcinomas tend to be more aggressive, and hepatic
metastases and tumor thrombus within the adrenal vein or IVC
may be present at the time of initial presentation. he presence
of metastases and tumor thrombus confers poorer prognosis.
Management of adrenocorticocarcinoma requires a thorough
imaging and biochemical workup to assess for tumor resectability.
48 he mainstay of treatment is surgery; however, despite
resection, prognosis is oten poor with estimated 5-year survival
rates of 16% to 38% and estimated recurrence rates at 85%. 47
Sonographic Features
Adrenocortical carcinomas (Figs. 11.11 and 11.12) are oten large
heterogeneous masses with areas of cystic necrosis, hemorrhage,
and calciication, as well as demonstrable vascularity or prominent
supplying vessel. Lobulated borders are common. he
adjacent veins should be examined to assess for venous
tumor extension.
Metastases
Adrenal metastases are the most common malignant lesions of
the adrenal gland and the second most common adrenal lesion